Provider Demographics
NPI:1003365172
Name:BAXTER, VICTORIA (LCMHC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RED LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1672
Mailing Address - Country:US
Mailing Address - Phone:706-836-1713
Mailing Address - Fax:
Practice Address - Street 1:39 RED LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1672
Practice Address - Country:US
Practice Address - Phone:706-836-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor